0:03 Thanks everybody for joining. This is episode 7 of Medicaid Managed Care in size. It's our webinar that we do only for managed care organizations. We are trying to kind of build building insightful community of mcos the kind of a neat thing that we're doing. Normally you guys are all and gals are all competing in different ways or may not get the kind of interact but here you can come together and share what's going on and all kind of consume the prayer.0:33 News and insights we've put together. So we thank you for doing that. We are always looking for your feedback on how to make this better. So fill out that survey that will come to you after the after the end of the show are your host today myself Cliff areas most of Medicaid as well as Richard topping Richard. If you don't mind say a few words led by know who you are if they haven't joined before pleasure. Thanks for having me and mr. Topping. I'm Council on health care practice at mints.1:03 The DC practice and also service clo it cares for us. So thanks for having me. Yeah, thank you for joining us for the first time in episode 6 very excited to have him here again today. And also we have sorry. I almost skipped over it. We have Chris Jensen in the booth. Chris is going to be Googling interesting things as we go along and tossing them out Chris. Give us a couple of words about yourself. You're my background is in the Medicaid technology space.1:33 With with EV implementations, I spent some time with with technology vendors and the currently consult to State's health plans and adventurers alike to to implement TV technology among other things in the Medicaid space. Thank you for being here and for folks who want to get in touch with Chris after the show, I'll put up his contact info here. I'll put it up again at the end. And if you've got a question for Richardson them to me, that was your preference last episode Richard all assume.2:02 That's the The the same next time and kind of helped coordinate. Perfect. Thank you. Excellent. You're welcome. And also in today's guest spot. We've got Abner Mason very excited for him to be here today. He's going to talk about mcos and Telehealth and messaging and some of the exciting work. He's been doing Abner if you don't mind give folks a quick look at what you're doing.2:25 Great. Thanks Clay. It's great to join you. So I'm having a Mason on the founder and CEO at consejo Sano which means healthy advice in Spanish were a patient engagement patient navigation company working with mcos now in 10 states to help them engage their hard-to-reach members, especially the members who are Multicultural and for whom culture and language is a barrier and we're using text messaging to do that really successfully.2:51 So I'm happy to talk to you about some of the work we're doing and why text messaging so important in The Medicaid space excellent. Thank you for being here and we'll hear from Abner after we do the Medicaid news for folks who want to get in touch with Abner here is his contact information and I will put it up again as well later. Here is our plan for today. I will do MCO news. I will have her guest spot with the abnormal do some rug watch we may or may not give you additional previews of black book The Q3 issue. It came out about a month ago.3:22 It depends on how much time we have and then Got some updates on the RFP tracking calendar and will also talk about there's some big RFP news. I think since last time we talked we'll talk about that at him Co news around, Texas.3:37 Alright, so first bit of news, oh real quick. I don't forget to submit your questions and comments as you as we go along. We've got a little bit of a new approach. We've been doing this about three years now or so and I think have always had a desire kind of leaving the webinar. Wish we could have had more time or which we could have collected our thoughts that kind of thing on a lot of the great questions and comments that you all send in we're going to do moving forward is going to collect those and review them.4:06 One big chunk and respond after the show that way everybody can benefit and we're going to allows also to kind of put together more more informational assets around the webinar itself. So not only will you get the the recording you also kind of see the Q&A that kind of thing. And then also we're going to post it. Y'all are really great about commenting everybody in the audience always has been we're going to post the best comments.4:32 I will put will default to it anonymously unless you tell us otherwise and that will also be The show notes page. I hopping right into it more states require value-based reimbursement and Medicaid. This is kind of a broad assessment of what's been going on particularly in Managed Care 22 out of 39 million care States now have value-based reimbursement of some type 6 have alternative payment models. I don't know enough about this to give details, but I do have the states that are listed as that New York. I've been tracking for a while.5:06 It's requiring 80% of MCO payments to Providers to be in value based contract by 2020 DC not quite as aggressive, but similarly bold 75% by this year and 90 percent by Twenty twenty one over all 48 states. This is including the fee-for-service states now have value-based payment programs. That's a wide range in terms of what that means. That although that is seven times what it was compared to 2014 Richard. What are your initial thoughts?5:36 On this yeah, this this this still to me is one of these, you know big broad policy ideas that everybody agrees in a what but nobody agrees on that how and so we you know, we all know we've got to transition the way we pay we've got to pay for Value, you know, not just for churn, but it's choppy iterative and you've seen one you've seen one and really when push comes to shove and you're talking about how States a plans and how plans pay providers it gets very very difficult to implement.6:06 These and so I am somewhat worried that it gets a little bit if it gets too complicated you move beyond the original intended purpose, which is essentially a higher value and better care. So we still have a long way to go on this I completely agree and value-based payment has become one of those things that just I don't know it chafes me when I hear it because I completely agree. We have a long way to go and it's not you know my mind. Yes. It is as simple as we should get better outcomes for more payment. 6:36 But I don't think we really spent a lot of time focused on that. Thank you move on to the next one. So the big news Anthony signal Molina lose big as Texas Awards Medicaid contracts in a related bit Molina disappointed by building dog, Texas contract laws ways protest. So as you can imagine we now have news out who the winners are who the losers are I don't have the full list, but these are the these are the multi-market.7:06 Nationals in terms of winners and losers lots of other local market plans, but I think you know, the winners that are in here heading is brand-new, which I think is a big deal and we can talk about that. I think a lot of folks thought at the might have been on the ropes of until recently in terms of wins and then sentain and uh, see or increasing their footprint, but the big deal is Molina, you know, losing up to a billion dollars in Revenue.7:34 And then my mind that's the big deal that came up on the the general news show a couple weeks ago 10 billion and cap half a million ABD members. So that's what this is for. There's a chip when expecting to be awarded in December also 10 billion Revenue.7:54 And the new contracts will start a little less than a year from now Richard. What are your thoughts on on this one? I think you got a two-sided challenge for Molina. It's not just it's not what they've lost but it's where they've won. And so Texas is a you know can be a challenging Market.8:11 The regions are all different some were very difficult to operate in and so this is you know, this is going to be a challenge for Molina as they go forward, but I but I liked it heard and liked your comment, you know about Etna and this is I think great news for that organization is they've worked really hard to rebuild. You know, they've had a few big losses over the past, you know year year and a half. So this is great news for them. Yeah.8:36 I completely I was I was really surprised when I saw this come out my other thought on this one is it's I'm almost pinching myself to say do we actually have an awarded Texas procurement because it seems like there were so many false starts on a few of these last summer so that You know, it is nice to see ya moving beyond that Edna again still talking about it and we talked about it in North Carolina. This one is almost almost don't want to cover this but not going away. I'm trying to cover it in a way that is not salacious but it is a salacious. That's basically salacious story Edna climb in the state rigged the Medicaid procurement.9:23 And tried to cover it up. This is of course North Carolina what I have there's some interesting things coming out now in the last few weeks on the you know, they're climbing Northline manipulate the process and originally, so if you look at the score in which we looked at that, I don't know several several maybe even an episode War and I can't remember when this was awarded if you look at the scoring that so there's these top four and Anna didn't make it in the top four.9:53 Hold that thought for a moment. They they've also filed a 6000 page protest. There's administrative law judge can hear the January where which really probably the most. I don't know if this is problematic or not, but there is a member of the state proposal evaluation committee cohabitating with the Blue Cross Blue Shield director in the state for healthcare transformation that person or a state employee. I think it's the same.10:23 Person says that she saw a document in which an originally was on the top floor and Blue Cross Blue Shield was not out was not was not in that pot for they were out and that's kind of at the heart of some of the document Discovery process right now. And then DHHS itself in North Carolina says romantic relationship is not constitute a conflict of interest Richard. Do you want to touch this one to ten foot pole?10:51 Do you have anything I will so the lawyer in me can't help but touch this this this is going from bad to worse for North Carolina. So so just you know, a reminder the environment North Carolina and North Carolina, it still does not have a state budget and that's a standoff between the governor who wants Medicaid expansion and does not want managed care to be implemented and and the Republican legislature that does want Managed Care implemented as was passed in 2015 and won't expand. And so originally this was you know, it's one of those salacious story.11:23 About you know again, you know a member of the bid review team and then a bitter, you know being in a romantic relationship that had been not disclosed and that's you know, again salacious and more of an ethical issue. The challenge now is you've got some real legal issues that are popping up in this. So the allegation is that now was actually the third placed bitter and then that a deputy general counsel for the Department of Health and Human Services at the request of this this employee was evaluating the bids.11:53 Went in and created a new category, but then pushed Aetna from third to fourth place and out of position. And then the DHS withheld that document format that when they file their bid protest. So now there's allegations of legal misconduct hiding evidence failing to produce it.12:11 And then there's one other issue still sitting out here in this case two, is that the way the bed sheets and this is also popped up in Louisiana some of the protests at the way the bid sheets were scored that That healthy blue was awarded a higher score for using CBS as their PBM and of course that and the Not only uses CVS and is owned by CBS. And so there are scoring irregularities, which is a substantive issue. But now you've got you know, potentially this issue around literally doctoring bids and then withholding that evidence. So this most assuredly is going to go to court and this is going to be a big deal. This probably does jeopardize implementation in, North Carolina.12:54 Right, which is interesting because I think I can't remember if it was you or if it was on this show last month or in between, but I think the the the assessment last time I talked about this was all there's other problems that are bigger than this for the implementation as the budget stuff. But this has right emerged as oh wait a minute.13:15 There is a ver there and I I don't see how something like this gets settled by Like were the Jesuits in front of now it seems like this is something if I was at and I would definitely go to the mat for unless until I got what I want it well and that is reporting that they actually have this document showing that they were one of the winning bids and then that it was changed and again Changed by one of the lawyers for the state who then fail to produce that document in Discovery.13:45 And so most assuredly this is going to go to court and whether or not that I mean, I think certainly that's going to pause the Station so remember North Carolina was supposed to go live on November 1 that got pushed to February 1 almost assuredly you're now going to see a push to July 1 without a state budget, but then if this gets tied up in court because the court order a full rebid. Does it order at not to be placed in the market? Because there are also allegations of impropriety as on other bed sheets. So it this this thing is probably going to get worse before it gets better. Right? So Chris Jensen in the booth.14:21 I'm thinking maybe you should be watching the Aetna CEO Twitter feed see if he's tweeting out copies of the document, you know and transparency.14:32 I'm doing that I'm doing that right now taking a peek. Thank you. Richard good insights on that next story stays try new strategy put Medicaid enrollees to work. So this is of course a my work requirements. And this is an interesting.14:52 I mean, this is kind of a high-level analysis and they get into a couple of specific state, but and there's some other talk on work requirements to They will have to probably talk about as some Governors have changed hands that sort of stuff. But some of the dialogue is Shifting away from work requirements more towards tuition support or job training. There's some cool numbers in here out of Montana. So if you look at their expansion more than a third of them slightly more than third of them got Employment Services 4200 of them got one-on-one training. I think this is the same. Yeah.15:26 This is the same one that of the sixty sixty percent of of the enrollees, I guess in the new category were already employed and 70% So including some of those others they showed interest in learning about part-time or full-time job. So I think we forget that for a moment that people would love to hear about you know a way to get a better job or a job entirely if they don't have one that kind of thing and now States I think are more apt to talk about employment as a key social determinant of Health.15:56 I think they realize that it's an important part of the discussion right and I just love Yeah, I love this from state. Senator are gonna love this quote. It's we're not asking great-grandmother to work in a coal mine or my guys in their 20s who need an extra push and it's just so concisely put because that's I think that's what I've been trying to communicate because in every single is its Crystal flipping clear all the exemptions, you know, that kind of thing anyway Richard thoughts on on this.16:30 You know, it's going to be a shame to see what happens in Kentucky with the change in administration there too. But I but I do think we are starting to see the policy behind work requirements start to Peak through the politics because up until now it's that's really that the whole issue has been overcome by the politics of it. But but you're right this is a social determinant folks that are engaged meaningfully and if you know if they're able to work that's work tend to have better health, you know, which is better for the program better for the individual. So hopefully now we can get some rational conversations morass rash.17:00 All programmatic implementations of the so we'll see but I'm sure there's still more politics to come. You know, one thing like one thing I think is a related thread or employer-sponsored Insurance subsidy programs. If you track those like that is by default a work requirement, you know, you got to have a job to have or sponsored insurance and I think I was I was reading something this morning.17:28 It might have been on the maybe I think is actually on Kentucky. I think they have a tiny one of these right now and there was to expand it and Indiana healthy Indiana plan 2.0 is coming out. I think I'm going to be something that too but it's interesting. You know when you when you basically say, okay. Well, we'll help you pay your private premiums versus bringing you into Medicaid. That's a whole other discussion. Nobody gets super ticked about that but it really is a work requirement.18:0 1It is going to want to watch to just clay, you know, just weighing in on that too is that I think some of the challenges has been to with the rollouts of work requirements the actual administrative function. And so I think that's important to as those systems get implemented and they know how to track it. You're not losing folks who are just dropping off the rolls because of an error. I think that's taken some of the noise out of it too. Right? Right. Yeah.18:25 We think there's a kind of a There's A Renewed push to say oh it just costs too much to implement these if I look at some stories from a couple of weeks ago 26 million dollars in Arkansas that kind of thing but I started comparing it to you know the savings on spending if you if you assume right that they're not dying in the streets because they were only from a population that was ever exempt any way or not exempt because they weren't grandma's and they weren't kids and you know, they're basically otherwise healthy 20 year old then.18:59 Yeah, my Arkansas math came up that they stop spending forty six million bucks. So I mean it actually ended up being save anyone. All right, next one Evelyn partners with Maryland Physicians Care to support Medicaid operations in Maryland, you know, this is we've talked about Evelyn a few times most notably with the I guess the passport bailout or how we think about it in this new deal.19:28 They're going to provide I'd sort of operational services to this MCO. I guess it's a physician with MCS. It's it's Implement. It's being implemented now for lobster underway in January 2021, but these are all the types of things claims Care Management, um provider provider Network management various things that they're going to provide, you know to these as we see these states pushing for provider lead entities as as an important part of their Managed Care strategy.20:00 I think one of the first things providers realizes they have no idea how to do all the stuff Health Plans do so they need help with this kind of stuff. But any thoughts on this one? No, I just think Evelyn, you know, it continues to be adaptable.20:14 I mean it look at where their Market opportunities and they and they they're continuing to you know, find ways that they can meet the need passport which essentially was a conversion acquisition of a kind of standard plan and then now, you know back off saying which is more traditional or business model, but Evelyn continues to look at opportunities and ways to do it and so it's interesting to watch.20:38 Chris you got anything on Evelyn from booth.20:44 No, nothing in the rags. Just just to piggyback on how they've done an effective job. I think bringing technology into that equation to help to help exploit opportunities. And certainly the I think that continues to be the case, but nothing I've seen on from the boots. All right. Thanks. One thing to watch for Evelyn to is with the passport acquisition where that's Evelyn's first.21:09 Let's call it front office plan operation there in the In a middle of a of an acquisition Kentucky it'll be interesting to see if passport is awarded a contract now that it's Evelyn and so that's going to be this will it means you can see if they make the transition for back-office the front office and Kentucky's their first test very very good. Yeah, it is I wouldn't have thought of that. But yeah when so how long is this past the past but recently one right so they have X amount of years to ride on that or no?21:41 No, some so bids are in and waiting on state state the state award in Kentucky. Nobody knows exactly how or if the awards are going to be impacted by the change in administration. I think the thinking is that these Awards will come out on schedule and I want to say it's spring the awards will come out on schedule and then you know any policy changes would come in addition to that. So so I think you know, I think we'll know sooner rather than later, you know.22:11 What happens if a sport right? Thank you for right. I forgot about that. It was really they they needed them passport needed them just to even put in a responsive bid on solvency. Correct? Right? Right, right going over to West Virginia more Edna stores DHHR tap that into managed care for West Virginia foster children and then a similar story on one of them one of them kind of brought out a little bit more of the perspective from some of the the Foster.22:40 Her parents, but the highlights are they they won this this contract. I guess they've actually been State since 1996 and what this is real live right now. I've got a hundred thirty seven members and it's going to take I guess 20,000 of them and move them into more intensive care coordination that average ft per member is an old note ignore that one on there on the screen.23:04 If you're watching the video foster parents expressing concern over disruption and services provider Network, I think Just don't know what to expect. I would imagine barring any, you know missteps on the Edna side. This would make life a lot easier for foster parents because they probably been coordinating this care of themselves with I would imagine very little help. But anyway, that's you know, that it's always track these these foster care winds made in addition to you know, personal compassion for this population.23:38 I always do it is very strategic to because they know once they award these they don't really like to switch up mcos much for this population. What are your thoughts on on this one for sure. Well, just we've got another RFP out for the same in Indiana so that you can see more and more of these and then just to the end point, you know, I know is very fashionable for a while to say, you know, it was on the ropes and might not recover but you know, I mean, it does 60 billion dollars a year in government program.24:06 So anybody that counted them out is starting to see that and you know Can win and and we'll win. So how do that to that point? How much is this is now maybe like new juice, you know with the CVS world, you know you how much do you think do you think that integration is very far along and maybe now there's lots of new assets and resources as it's happening in on their bids or is it what's your opinion? There are no I think so.24:39 Look, I mean some of it the whole me the point of the acquisition was vertical integration and greater opportunities to leverage different parts of the market to get to these types of high Acuity populations and better outcomes at lower cost, you know, whether or not they're leveraging that whether or not this is just they had a reset get the right team in place, you know, get the right systems in place whether it's just their size regardless, you know at very much is picking up some momentum and we're just starting to see it multiple markets.25:09 Right. Well what one one last dying gasp of this thread that I'm implying with foster care in particular pharmaceutical Mansions a big deal. Yeah, right plays and other things but okay. It's going down to Florida got you know, good story feel-good story here of Health Plans getting good grades, and then we'll talk about in a minute how everybody's got knives out over changes to the assignment algorithm down.25:38 There but this story this is first I thought this was kind of the okay ncqa just release dated. Everybody does their press releases on you know, hey, we're a top whatever plan but this is actually I think a survey that the state itself did see you've got Beth get er done.25:56 Their delivery of news is news and the punchline is the vast majority of them are pretty happy 77% of them their care and access to care between 8 and 10 They've got about 3 million Medicaid managed care. I guess I was surprised I didn't maybe I don't know enough about kind of normative satisfaction, but I didn't do you Richard do you typically see this level of of high-scoring by members of plan? No, but I mean think look this is just a reminder to me as I read this it's a reminder that the only thing worse than than plan run Medicaid.26:38 Care is government-run Medicaid fee-for-service. So at this point you don't have to outrun the bear you got to take care of your members. You got to meet their needs. You got to do it, you know within capitation. So I'm not surprised to see these results and I think this is good news. Thank you. Thank you. Let's stay in Florida.26:56 So this was interesting to me and all this is the context that helps all this make sense is they, you know, there's recently a bunch of new plan insurance. I guess last year with the award and that's that's all fine. And well until you start try to figure out well who gets you know Auto assign members or whatever and there are some things in the current Formula which you're probably pretty standard but they don't really benefit the new guy and so they're disagreeing over the algorithm.27:31 The total Florida market right now is about 90 billion dollars and the two main options that have been put out. There are just you know, any meeny miny moe around robbing or a minimum enrollment for plans and that last part really matters to the new ones because the current algorithm does logical things like keeps family members in the same Clan or if clay was in the plan in 2019 re-enrolling them in the same plan in 2020.28:02 But this all leaves less opportunity to increase enrollment for new plans. I don't know where this will. Try mean. This is pretty fresh from what I've seen I think last week is when the the latest piece on this came out, but I don't I certainly don't have a good answer. I mean, it makes sense the the current Formula but I also understand that it it creates a barrier for any new entrance to actually build up enrollment any thoughts on this one Richard knowing probably Kristen Abner both smart.28:31 About this, you know, then I'd be but this is I do think you're gonna start to see more of this, you know where we've largely kind of completed the transition from paper service and Most states to manage care. This is how plans are going to compete in the market. So you're going to start to see more of this people are paying more attention to how these algorithms work how they're supposed to work how they actually work as plans get better at data and analytics to they've got the ability to push back a little more than the probably had before too.29:01 So we'll just start to see more and more of this. I think right. Well, there's so many of them. I guess it also matters more and more kits for there's lots of mcos.29:14 Chris you're actually down in Florida, right and it is any of this showing up kind of in the the General Media or is this all Healthcare won't Swanky stuff my lost Chris. I think he's traveling today as well. Sorry.29:32 I was I was I was on mute there, but I was just going to say that there's not a lot of the General Media about it that I've seen but what's interesting is if the scoring I members has gone up and and really when the when the Managed Care bids were awarded last year the the companies that are that the big change of the Guard was certainly well care one pretty large Humana came in into the market and centene. So a lot of the big Winners that you just pointed out earlier and in Texas and losers. I think that is also kind of matches up with what what Florida went through about a year ago.30:09 So it's so I thought if I again I I can't draw it inside from other than to say that I think it's noteworthy.30:15 Right well and it's I think you were starting a drug connect the dots of the two stories, you know, if they Like a any real disruptive change on this might make those members satisfaction numbers go down.30:29 It might not be a good move it around go ahead and certainly in elements of of managed care. I know they're there was for a period of time there was it there's a moratorium on new licenses being issued in certainly in the Home Care space was so it's like the way people were being served.30:45 I think was was was in large part, you know improved by better service from the plans with no real material changer disruption from some of the other ways that plans had a contract out those Mrs. And again, it's noteworthy. I don't know if it's if if that makes it inside out of it, but I find it. I find it interesting is as a Floridian. I mean if I was a one of these smaller plans at just one. I mean, I would I be like, oh great. What did I really just went not maybe a dead end. I guess. I'll keep an eye on it. There's an interesting one and sure stake in firm control ensures. They confirm.31:29 ERM stirs concern in Arkansas and reach 100 lat this is about the passi stuff and last time you you were so it actually helped me be able to actually understand what was going on in this story. But if we if we start out with the important foundation that the past these are meant to be providers lead for SMI and idd members this centene Mercy Health Partnership appears to maybe not honor that so since then partner with Mercy Health in 2017.31:59 Centi known 74% of that deal and so it doesn't really kind of hard to argue. I guess. It's provider LED. I'm so we'll touch on that in a minute. But there's also some good pmpm numbers any time I see those I grab those because all my Consulting clients want to know what these are and I should want phase one, which was just, you know, getting to know you and coordinating care only about a hundred seventy three bucks a month per member per month phase two, which I think we're in now that are paying for all care.32:29 Anywhere between basically Grand 12 Grand per month to cover all the services from March to June about 540 million was spent on past the 123 million of that going to Arkansas Total Care. I've also started trying to call out waitlist. You got 4,500 people receiving the services under this and 3,300 wait-listed Richard thoughts particularly around where this goes on this.32:58 Not provider majority owner thing was in pain but also own any of this stuff because I know you've got some good thoughts on it. Yeah. Well, Tommy One technical point, you know one is the state of Arkansas did Issue a provider license and that may not be the right technical term, but did Issue a provider light or provider license to Life share? And so this was I think this was transparent state of Arkansas as centene went into it.33:23 And so so I get those questions now about whether they've complied with the spirit of what They're trying to do but you know, but I do think sent teams compliant with the law and was transparency of Arkansas. But to me, the reason why the story is interesting is it's because of what's not in the story. So if the story essentially is the technical corporate structure of sentence participation in the market and not you know access quality remember, these are the most difficult to serve individuals in Arkansas. There are less than a year into this is just started lat, you know last winter.33:57 So the fact that that they've moved Beyond I mean they are serving literally the most difficult serve individuals and the fact that it's not issues around care and access. I think that that shiz Arkansas is probably doing this right and making progress very very good point and it shows that probably some Journal somewhere is trying to look for something to make some Act Right. Very good point. Very good point. Let's see, I think I might okay now the next one's in California's Abner. You may be seeing some of this out on your own.34:27 Neck of the woods, sir. Please weigh in if you do but many California nursing home residents told to find new homes and then nursing home denials and California raised concerns about larger move to managed care. So basically you got it so far as I can tell right now, it's one plan. Send cow help is sending letters to Medicaid members and nursing homes saying we're not covering. What's what's been covered for your facility based care.34:55 The Advocates are all pretty concerned because Nursing homes are all getting moved into Managed Care in the new procurements in 2021 implemented 20 21. I think we'll see him early next year currently 29 counties have nursing homes in Medicaid managed care. It'll be all 58 mcos can still pay for intermediate care. So just lower level of care. But this is kind of an early rumbling of what it will be like, I guess by default to have an M ltss program in a lot of ways at least on the facility.35:27 The side Abner Center out in California. Does this does this come up in any of the work you're doing or no? It has not yet come up. So no not yet hasn't bubbled up yet. Yeah, I think I think it's just beginning to and it will imagine this will be a really sticky thing. Just knowing you know, the power of the nursing home Lobby in Most states Richard any thoughts on this one.35:55 No, but I see this as just part of the broader and slow movement, you know from institutional based care for these populations into more community-based settings. And so some degree whether it be a nursing homes. Don't care homes, whatever it may be based on the state.36:11 This is to some degree been an easy button for high Acuity populations where you have some care for these folks, you know, and it's clear that that what we're trying to do is move folks into the least restrictive settings to be in a community to be as fully engaged to the maximum extent of their Their capability and ability and so this is just there's going to be more of this the problem though is whether it's nursing homes or whatever. These are capital intensive business models that don't have the flexibility to adapt quickly to changing requirements. And so you're going to see more and more of this I think right. Thank you. Let's go to Virginia.36:50 And you know, some of this is related to this is kind of another ltss story and not all of it, but we'll talk about the parts their costs are showing down 212 million dollars this year.37:04 They tried to tie it to his Mansion but some there's only so much we can strain logic I guess but it's projected to rise 674 million and a 2 in the two-year budget that they're entering into so the states really A lot of the decrease in cost was 212 million dollars lower enrollment in their long-term care program and the the real kicker is going to go up, you know more than three times that in the next budget cycle and that some of that is to make ncos whole because and they're going to add three hundred thirty thousand members due to expansion but MCO suffered a lot collectively, I think suffered 268 million in the ltss program in the last year.37:50 And then again, sorry ignore that last note. I got some cleaning up to do on that slide. But you know, this is interesting to me to me. It's a big deal that we're already projecting, you know rounding up to a billion dollars in the next budget cycle. I guess I were two year period and we're already trying to deal with you know, I don't know if we know enough to say insufficient rates, but clearly things weren't set correctly to pay them.38:20 He owes on the only long-term Services side, but Richard thoughts on on this in the Virginia Market, but it's just interesting, you know for me to see this in a given that markets, you know, right next door and just hadn't really heard anything about it. You know, I think the rate issues and Illinois the right issues in Iowa or well understood and well known but was not aware of the issue in Virginia. So just be interesting to see whether this is a simple rate adjustment issue or it's a structural or programmatic issue like it's been in the other.38:50 two states, right Last one, I think an MCO knows we're going back down to Florida. There is this is related to kind of how to deal with budget challenges for an ID program. The current program is called I budget it's got that little I in front of it. So this must have been created back when we put a little eyes in front of everything to try to look hip like apple. So maybe early two-thousands. It serves 35,000 people are 20.39:22 Wait listed, they are considering you know how to deal with I guess budget crises. One of those considerations is a individual cap. So if clay was in this program, you can only get you know, $205,000 and services is one of the things they're saying right now, they're not considering moving out of the in a managed care, but I just can't see how that won't get on the table at all.39:45 Richard what are your thoughts? What are their options here? Yeah. I mean I agree with you but it's not going to flip side to the Vit D question in Florida and everywhere else is not it's not just the budget issue. It's the quality of care or lack thereof that these populations end up sort of so these are real last folks completely untouched. You know it all by managed care or by choice. So these are folks that I mean again use care from Cradle to grave and oftentimes.
40:15 You know have no choice it's whatever their assigned by the state. And so so the flip side of this is as a New York's a great examples of how providers and families can actually move this forward when the rest of the population is removed in folks have choice these population start to say, hey, we should have the same opportunity to and then that choice drives competition that you know, arguably provides increased opportunities for them as well, too. So that's going to hit in Florida.40:43 It's just a matter of time and then you have the budget Crunch and that's that's what we'll move this. Thank you. I'm going to skip m&a tidbits and I'm going to skim just looking at Tom. I'll hit a couple quick hits and miscellany so advocates in Illinois or trying to delay the moved foster care to him cos and when we put out the show notes, you'll have a link for this stuff if you want to look at a better centene in two different markets is paying back cash.41:16 For hitting for missing mlr requirement. So in Arkansas and in Kansas and Richard already talked about how you know, we're realistically probably looking at a next summer now delay. It was first delayed from November to February and now we're probably looking at next summer. My guess is we'll get that official delay here shortly. Don't forget to send your questions and comments from under the new approach. We're going to look at them all in one big group to where we can sort of more in-depth and thoughtfully and we will post the best comments anonymously.41:45 So now I'm gonna hand it over to Abner. He's going to talk to us for five to seven minutes. But all the good work. He's doing mcos with mcos and messaging and Telehealth. So Abner my hand it over to you and looking forward to hearing your thoughts. Sure. Thanks Clay. So but I wanted to talk about was just the challenge that ncos are facing around the country when it comes to how to engage their their members and we all know that engagement.42:15 important and that lets engaging is the key to achieving all the other goals that we have in terms of quality giving people in and getting them to seek Care at the appropriate levels, you know reducing ER unnecessary are you so engagement is just so important in the Medicaid space that I actually think that it's probably the most important fact because you can't engage members you're not going to be able to achieve any other goals you have And the problem we have today there was that the way that members want to engage is primarily through their mobile phone and in particular through text messaging Medicaid folks communicate just like the rest of us in American society today and that is by text message. If you asked if you forget any group of Americans together anywhere in the country with very few exceptions, if you ask them how they communicate with their family and their friends they'll tell you it's my text message. They don't mail letters anymore.43:14 And even the They'll take people don't even answer calls, especially when it's from a number they don't recognize and they certainly, you know, I using even email less and less and for low income people in the Medicaid Market in particular text messaging is the way they communicate and we can say he'll sign on my company.43:33 We focus a lot on Multicultural members that is people for whom culture and language is the barrier and in many of the Medicaid programs across the country a significant portion of the membership is Cultural to the two data points California biggest Medicaid program in the country. It is 81% 81% Multicultural Texas is 79% Multicultural. And if you round out the other three large states New York is 68% Florida 66% Illinois 62% And so when it comes to the Medicaid Program for a host of reasons, we need to figure out a way to communicate with people in the way that they prefer to be communicated with and that's text messaging.44:15 But today in the US the vast majority of ncos and I mean the vast majority are not using text messaging to communicate with their members. So if you think about this, it's 2019 you have members who prefer to communicate in one way and the mcos who are saying, you know in the vast majority of them we can't do that. We won't do that. And so we've got to fix that because if we don't we talk a lot about meeting people where they are if you're unwilling to use the mode of communication.44:45 Ation of people prefer, you're not meeting them where they are. And so we need to help and CEOs. I have not run into an NCO yet. We're working in 10 states can see us I know and I've not yet to meet again. CEO who doesn't want to text their members they all want to but they're hung up. What's preventing it is some old regulation and laws that that in some cases are being missing misinterpreted and some cases.45:08 It's just too conservative of of a position that the legal departments are taking at the plan so when I'd love to To just encourage ncos a couple things one take a look at some of the examples where we're making progress a quick one is California in the last about four months ago that the California Department of Health Care Services, the regulator for Medicaid and California issued a policy for all Medicaid managed care plans in California allowing them to text their members and giving them guidance on how to do it.45:38 So they've laid out the clear a clear policy for mcos in California, every state needs to do that and what of the ways we get more states to do it is the ncos have to put some pressure on their regulators and say look we want to do this. We want to engage with our members. We want to meet them where they are. But we need your help State and part of the reason we need the states to step in as because there is some federal regular federal law that is a problem. The telephone consumer protection act which was passed in 1997 almost 30 years ago and it does provide some constraints. It's and I won't get into the details of the bottom line is the law says you can't text him.46:15 Unless you have permission to advance from them to text them and of course that's difficult in the Medicaid space. So but there are ways around that and and we can get into more detail if you'd like, but we are very focused and sales on on helping our MCO Partners clients to put together a strategy that will allow them to text their members. And as I say key to that is State action and California's already done it we're working. We just work with Rhode Island, Rhode.
46:45 And is now allowing it and we're working with other states, but that movement will happen more quickly if the mcos get into it get into the action and start to Lobby their Regulators to say we have to do this. We can't meet any of the other goals you have for us if we can't engage with our members and to engage we need to text them.47:06 Thank you. Thank you very much. And there as you can tell Abner's passionate about this, I am indeed. I just heard I think I just heard you throw down the gauntlet to the MCO. So you want to you want to change some things then let me help you fix that. So here's Adams contact info and I think you and I'm in Chicago either this year or last year. I mean I've been able to follow your success. 47:34 And and progress on this so thank you for being here today. I know I know the mcos are always looking for new ways to impact number care. So thank you for being here today happy to do it. Thank you. Let's do some quick reg watch stuff just looking at the time and then we'll close out an RFP.47:53 So the highlights for those who go the track on the reg side and Richard just hop in anywhere you want on these I'm going to do a bunch of FY eyes for the most part cms's AMD Seema released the news of a new strengthen fiscal accountability and Medicaid rule jewelry. This is the m far the Medicaid fiscal accountability regulation. It covers a lot of different things. I'm sure we'll be hearing more about it over the next several months but things like supplemental payments various financing definitions questionable financing mechanisms.48:30 I would love to see things like a GTS and Magic Money provider taxes and They're personally will see those have been a bit pet peeve of mine for years. And I know I've got various if there were any Medicaid directors listening their heads are exploding because they love this time never heard of called Magic money, but that's great. I'm going to steal that from you. I've been calling him Magic Money Every time. I see it. But anyway, I called money laundering indifference. Look for more of that under that rule. I love how they always drop a pretty big rig.49:04 The name is there is a Florida Bill to eliminate a million dollar cap on benefits. If you're tracking in Florida, I guess maybe even in the chip program. There's a camp there and they're trying to get rid of that cap, Georgia partial expansion proposal was released November 4th. That'll be interesting. Georgia is overhauling their exchange and Marketplace as well. If you if you track those such things the states that are exiting the federal exchanges and going to State the new Kentucky Governor has promised to rescind the work requirements waiver.49:34 We talked Got a little bit of top the there's a Louisiana governor candidate vowing to freeze Medicaid enrollment the Tennessee block grant proposal received its has done with this public comment period and guess what? Everybody said they loved it. And please please pass the apple pie. No, of course not they mostly the folks that hated. It came out and everybody supported estate home, but they're revising the public comment.49:57 They're revising after the public comments and they're going to resubmit their won't be comments on the resubmission if you back Exchange stuff at judge's order 1.6 billion and CSR payments back to a hundred different plans. There is a short list of states preparing a plan B if key parts of Ocker overturned if you can follow in that case and then Arizona quietly delayed work requirements. How's that for a lot of information in one breath? Pretty good. Thank you. Any any of these in particular you find interesting Richard or want to weigh in on I find them all interesting, but you did it.50:34 Perfectly, thank you. Thank you. Let's see. I'm not going to go into but don't forget. You got the nonprofit right always want to make sure people have if you're interested in subscribing a black book. The new issue is out these Rob Garnett and Dave Timber are the exclusive interviews. Here's the list of the vendor reviews that went through our 55 Point review.50:59 Let's do some quick rfp's here is the update to the Schedule I'm running a room here. I got to get a Consolidated last month. I had a good bit of activity. We talked about the Indiana Hoosier care. I'll do a quick profile on that looking for a warden the duels Demos in Massachusetts this month looking for Texas and December the star and Chip. I need to update this star plus one here to show the actual the one we talked about earlier and I'm thinking that Indiana is Chan.51:34 You are but we'll get into that in a minute DC longer-term. So pushing in the next year DC's now showing spring of 2020 California still 2020. I think most people are expecting to q1 Q2. And then Ohio still 2020, Indiana. We did talk about that earlier. So I'll cover a little bit more was released just a few days after we did the last episode proposals are due right after we get back from our New Year's celebrations implementation April.52:04 Year from next April there's 90,000 ABD members they have to be age 65, I think right now they also include some foster care coordination but the trying to spin that out and that's where the yeah, that's what I thought it was interesting they ever put them together but they're trying to take them apart and they simultaneously released an RFI. This is interesting to me. They got to have a decent of in place by April 20 22 so that you know, there's probably a year lead-up of that.52:34 I I think submitting those contracts to see a mass.52:39 But at one point four billion in annual revenues not institutional care of Coordinated Care and they're going to do a health screens to determine the level of care coordination needed. So for all you folks are involved in the various pieces of the assessment world. This would be one to watch incumbents are Anthem and sent an MD wise I think used to be in there until maybe a couple of years ago. And then they I don't know why they're no longer in that data. Here's the scoring for folks that are interested in that.53:08 So I'm sure we'll be talking about this one a good bit more class A good correct correction to just right. It's an RFP on a BD Indiana as an RFI on foster care. So I misspoke earlier. Thanks for correcting us. That's fine. As you can see. I've got errors throughout all my I'm glad I guess they're I don't have much details on the RFI do have copies and links.53:33 I think this RFP if anybody wants to just send it out the And don't forget to put those as we go procurement quick hits and then we are almost done. I was looking at the healthy Indiana plan waiver renewal 2.0 this morning that came out in terms of the for the renewal Louisiana mcos have agreed to those one-year emergency contracts in North Carolina the healthy opportunities RFP. Did you release?54:01 I'm glad to see that wasn't delayed with all the drama, I guess for lack of a better term in the car real state. That is a very cool RFP.54:12 If you don't know about it, send me a note but it's creating these local provider entities that basically will have to act upon the stuff found when the mcos have done these assessments of social determinants needs 17 lost some Oregon footprint that was interesting to me after it failed to build out a provider Network the Tennessee RFI as part of their normal schedule of renewals is released and Rob talked a little bit about that in the black book interview did and then Texas is awarded some dental contract separate. We often don't track dental and the same with the same fervor as we do other things, but they have awarded those two did a question C and A and uh see next show will be 2020. 55:02 Dr. Kwame low, right Will Be Our Guest she's going to talk about some of the great work here sources doing with members who are recently leaving prison. It's a pretty cool pretty cool things going on there as always need help with any of this kind of stuff proposals implementations Fender valuations were if you to have comments on the show, please send a note clay. It was like a.com and then don't forget to do the survey so we can continue to make this better and then finally for those of you all that are here.55:33 For the see you the code this episode is latency. So send me an email client most Medicaid.com and your first and last name and we will send you a certificate of completion for attending today. You'll get one one credit and we appreciate you being here. So I'll leave this up for just a minute more.if you stepped away to get some coffee. So latency the see you go and that is it for episode 7.56:03 Thank you for being here Richard and and Abner and Chris, and we look forward to looking at all the questions in the comments y'all spend today. Thanks. Thanks. Gentlemen. Have a good rest of the afternoon. Take care.